A retrospective cohort study of risk factors for mortality among nursing homes exposed to COVID-19 in Spain.

Long-term care (LTC) facilities have shown remarkably high mortality rates during the coronavirus disease 2019 (COVID-19) outbreak in many countries1, and different risk factors for mortality have been identified in this setting2-5. Using facilities as the unit of analysis, we investigated multiple variables covering facility characteristics and socioeconomic characteristics of the geographic location to identify risk factors for excess mortality from a comprehensive perspective. Furthermore, we used a clustering approach to detect patterns in datasets and generate hypotheses regarding potential relationships between types of nursing homes and mortality trends. Our retrospective analysis included 167 nursing homes providing LTC to 8,716 residents during the COVID-19 outbreak in Catalonia (northeast Spain). According to multiple regression analysis, COVID-19-related and overall mortality at the facility level were significantly associated with a higher percentage of patients with complex diseases, lower scores on pandemic preparedness measures and higher population incidence of COVID-19 in the surrounding population. When grouping nursing homes into eight clusters based on common features, we found higher mortality rates in four clusters, mainly characterized by a higher proportion of residents with complex chronic conditions or advanced diseases, lower scores on pandemic preparedness, being located in rural areas and larger capacity, respectively.

Optimización de la gestión del dolor postoperatorio basado en una nueva herramienta tecnológica. Mapa del dolor / Optimization of postoperative pain management based on a new technological tool. Pain map

Introducción: En el año 2005 el Ministerio de Sanidad, Servicios Sociales e Igualdad (MSSSI) impulsó y promovió la Estrategia de Seguridad del Paciente del Sistema Nacional de Salud (SNS), en colaboración con las comunidades autónomas, que integraba las aportaciones de los profesionales sanitarios y de los pacientes a través de sus organizaciones. Uno de los objetivos de las prácticas seguras era la necesidad de prevención y control del dolor en el adulto y en el niño, incluyéndose la gestión de este en los estándares de calidad. En el Hospital Universitario Germans Trias i Pujol (HUGTIP), en el año 2016 se inició la elaboración de los indicadores que se querían evaluar para una mejor detección y eficiencia terapéutica del dolor agudo intrahospitalario de cualquier área y que finalizó con el diseño y creación de lo que denominamos "Mapa del dolor". El objetivo fue diseñar una herramienta que, a través de la variable clínica dolor, permitiera mejorar la visualización de esta y extraer los datos estadísticos de los indicadores defi nidos para una óptima gestión del dolor dentro de un hospital universitario de tercer nivel. Material y método: Análisis descriptivo de la herramienta que denominamos "Mapa del dolor" en el Hospital Universitario Germans Trias i Pujol (HUGTiP) durante el año 2016. Se incluyeron todos los pacientes ingresados en los que el registro de dolor se realizó a través de la historia clínica informatizada GacelaCare(R). Considerando el dolor como 5.ª constante, la variable principal fue el registro de la intensidad del dolor mediante la escala visual analógica (EVA) o escala verbal numérica (EVN) en cada turno de enfermería. El procedimiento de creación de la herramienta para la elaboración del denominado "Mapa del dolor" se realizó con la colaboración del Departamento de Sistemas de Información del HUGTiP, junto con miembros de la Unidad del Dolor. Resultados: El "Mapa del dolor" se fundamenta en el registro de la intensidad del dolor mediante la escala visual analógica (EVA) o escala verbal numérica (EVN) por turno de enfermería, acción previa imprescindible por parte de enfermería. Permite visualizar en la pantalla los registros de la intensidad del dolor de todos los pacientes hospitalizados de manera simultánea y en tiempo real. El "Mapa del dolor" identifi ca los registros con distintos colores a modo de semáforo del dolor, en color verde marca los valores de EVN entre 1-3 (dolor leve), en color naranja EVN entre 4-6 (dolor moderado) y en color rojo EVN entre 7-10 (dolor intenso); asimismo señala con una franja de color morado aquellos pacientes operados el día anterior, facilitando el control del dolor durante las primeras 24 horas postoperatorias. La explotación estadística de los registros informatizados de dolor permite obtener resultados de los indicadores relacionados con su gestión, previamente defi nidos por nuestro hospital. Discusión: El "Mapa del dolor" es una herramienta innovadora que permite desarrollar con garantías la efi ciencia de las unidades de dolor agudo de bajo coste

Introduction: In 2005, the Ministry of Health, Social Services and Equality (MSSSI) promoted the Patient Safety Strategy of the National Health System (SNS), in collaboration with the Autonomous Communities, which integrated the contributions of health professionals and patients through their organizations. One of the objectives of safe practices was the need for prevention and control of pain in adults and children, including management of the same in quality standards. At the Germans Trias and Pujol University Hospital (HUGTIP) in 2016, the development of the indicators that were intended to be evaluated for better detection and therapeutic effi ciency of acute in-hospital pain in any area ended with the design and creation of what we call as "pain map". The objective was to design a tool that, through the clinical pain variable, could improve the visualization of pain and extract statistical data from the defi ned indicators for optimal pain management in a university hospital of the third level. Material and method: Descriptive analysis of the tool we call pain map at the Germans Trias and Pujol University Hospital during 2016. The population was all patients admitted to hospital units where the pain registry was made through the GacelaCare(R) computerized medical record. The main variable was the recording of pain intensity using the Visual Analogue Scale (VAS) or Numeric Verbal Scale (NVA) by nursing shift considering pain as the 5th constant. The tool creation procedure was carried out with the collaboration of the hospital information systems department together with members of the Pain Unit for the elaboration of the so-called pain map. Results: The pain map is based on the previous action required by nursing which is the recording of the intensity of pain using the Visual Analogue Scale (VAS) or Numerical Verbal Scale (NVA) in turn considering pain as the 5th constant. The map allows to visualize on the screen the registers of the pain intensity of all hospitalized patients simultaneously and in real time. The pain map identifi es with different colors as a traffi c light of pain. In green color, the EVN values are between 0-3 (mild pain), orange EVN between 4 and 6 (moderate pain) and red color between 7 and 10 (intense pain). Likewise, it indicates with a purple band those patients operated on the previous day, facilitating pain control during the fi rst 24 postoperative hours. The statistical exploitation of computerized pain registers allows obtaining results of the quality indicators related to pain management defi ned by our hospital. Discussion: The pain map is an innovative tool that allows the development of low-cost Acute Pain Units to be guaranteed with effi ciency